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224 CHAPTER 10 ■ “Safe Water Saves Lives”

Health and Social Indicators
More than 85% of the population of Madagascar lives on less than US$2.00 per day
(Government of Madagascar, 2007) with half of the population falling below the
poverty line. Strikingly, 88% of the rural population lack access to safe drinking water
and only 36% of children age 12–23 months have been fully immunized—factors that
contribute to the deaths of an estimated 100,000 children each year (UNICEF, 2005).
Literacy rates are low, and only 68.9% of the population are able to read (UNICEF,
2005). Leading causes of death and disability include malaria, sexually transmitted in-
fections (STIs), diarrheal diseases, and adverse conditions arising from pregnancy and
birth (USAID, 2005). Despite these challenges, rates of infant and child mortality have
declined by more than 40% between 1997 and 2004 (USAID, 2005). These successes
can be attributed to highly effective public health interventions by the government of
Madagascar, donors, and nongovernmental organization (NGO) development part-
ners. During the same time period, there was a 50% decrease in the prevalence of di-
arrhea and a doubling of the percentage of those with diarrhea who received either
oral rehydration salts (ORS) or a homemade diarrhea treatment solution. In spite of
this notable progress, diarrheal disease morbidity and mortality, especially in young
children, remains a leading public health issue across Madagascar.

U N SAFE WATE R -R E LATE D G L O B AL D I AR R H EAL
DISE A SE B U RDE N

Today, more than a billion people worldwide lack access to improved water
sources. It is estimated that 1.9 million children worldwide die every year due to
diarrhea (Bryce, Boschi-Pinto, Shibuya, Black, WHO Child Health Epidemiology
Reference Group, 2005). High levels of child mortality continue to burden many
countries around the world, with diarrheal disease as the second leading cause of
death among children under age 5. Each day, nearly 5,000 children die from dehy-
dration due to infectious diarrhea.
Unsafe drinking water contaminated by microbiological pathogens is a major
contributor to diarrheal disease. About 88% of diarrheal disease is attributed to
unsafe water supply, inadequate sanitation, and poor hygiene practices (WHO,
2005). This not only leads to negative health effects, but also carries significant
other human and economic costs. A total of 443 million school days are lost each
year from water-related illnesses (UN Development Program, 2006). Sub-Saharan
Africa loses about 5% of gross domestic product (GDP; some US$28.4 billion an-
nually) from costs related to diarrheal disease.